Is PCV (Pneumococcal Conjugate Vaccine) 21 necessary for individuals who have already received PCV 13 (Pneumococcal Conjugate Vaccine) and PPSV (Pneumococcal Polysaccharide Vaccine) 23?

Pneumococcal Vaccination Recommendations for Those Who Have Received PCV13 and PPSV23

For individuals who have already received both PCV13 and PPSV23, a single dose of PCV21 is recommended through shared clinical decision-making, with administration occurring at least 5 years after the last pneumococcal vaccine dose. 1

Age-Based Recommendations

Adults ≥65 years

• If you've received both PCV13 and PPSV23 (with PPSV23 given at age ≥65 years):
  • Shared clinical decision-making is recommended regarding administration of either PCV21 or PCV20
  • If decision to vaccinate is made, administer a single dose ≥5 years after the last pneumococcal vaccine dose 1, 2

Adults 19-64 years with immunocompromising conditions

• If you've received PCV13 and 2 doses of PPSV23:
  • Review vaccination recommendations again when turning 65 years, OR
  • Consider a single dose of PCV21 or PCV20 ≥5 years after the last pneumococcal vaccine dose 1
  • If PCV21 or PCV20 is used, the series is complete with no additional doses needed 1

Adults 19-64 years with chronic medical conditions

• If you've received PCV13 and 1 dose of PPSV23:
  • Review vaccination recommendations again when reaching age 65 years 1

Clinical Decision Factors

When deciding whether to administer PCV21 to someone who has already received PCV13 and PPSV23:

1. Time since last vaccination: Must be ≥5 years since the last pneumococcal vaccine dose 1, 2
2. Risk factors: Higher priority for immunocompromised individuals or those with chronic medical conditions
3. Age: Adults ≥65 years may benefit more due to waning immunity
4. Local serotype prevalence: Consider regional epidemiology, especially regarding serotype 4 coverage 1

Important Considerations

• PCV21 contains eight pneumococcal serotypes not included in previous vaccines (PCV15, PCV20, and PPSV23) 1
• However, PCV21 does not contain certain serotypes present in other vaccines, including serotype 4 1
• In regions with high prevalence of serotype 4 disease, this may influence vaccine selection 1

Vaccine Administration Pitfalls to Avoid

1. Timing errors: Ensure at least 5 years have passed since the last pneumococcal vaccine dose before administering PCV21 1
2. Unnecessary revaccination: If PCV21 or PCV20 is used, the series is complete and no additional pneumococcal vaccines are needed 1
3. Geographic considerations: Be aware of local serotype prevalence patterns that might affect vaccine choice 1, 2
4. Documentation errors: Clearly document previous pneumococcal vaccinations to avoid inappropriate revaccination or missed opportunities

The evidence strongly supports that PCV13 followed by PPSV23 provides good protection, but the addition of PCV21 may provide broader serotype coverage for those at continued high risk of pneumococcal disease, particularly when sufficient time has passed since their previous pneumococcal vaccination.